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At least 91 records · Page 5Linked to original sources
PubMed1995

Rehabbing Medicare. Is managed care a cure-all or just a crutch?

Money, or the prospect of saving it, is what's rallying many in Congress around supporting managed care as Medicare's magic bullet. And financial, as well as community, incentives are certainly helping to push Medicare managed care programs forward in the delivery system. But will those programs accomplish everything their advocates expect?

California↗
PubMed1994

Abdominal obesity and mortality risk among men in nineteenth-century North America.

The health consequences of an adverse body-fat distribution (e.g., android, upper-body, visceral) have only recently concerned the medical community. Ninety years ago, however, actuarial study demonstrated the relationship of body-fat distribution to the mortality experience of insured, North American men. Thirty-four insurance companies pooled their data on males issued life policies between 1870 and 1899. Special classes of risk were defined by weight for height at baseline or by the observation that abdominal girth exceeded the girth of the expanded chest (abdominal obesity). The mortality experience of each risk class was compared to an age-stratified, actuarial table of the period. We present new analyses of these historical data relating specifically to the mortality impact of abdominal obesity. Among 163,567 overweight men, the prevalence of abdominal obesity increased with age and with degree of overweight. Among moderately overweight men, those with abdominal obesity experienced 133% of the expected mortality rate compared to 112% of the expected mortality for those who were not abdominally obese. Severely overweight men with abdominal obesity experienced 152% of the expected mortality compared to 135% of the expected mortality for severely overweight men who were not abdominally obese. We believe this nineteenth-century, acturial study of waist and chest girths was the first demonstration that body-fat distribution can influence longevity. These early actuarial findings, taken with more recent reports, establish that abdominal enlargement, but not necessarily an 'upper-body' fat distribution, constitutes a major health hazard. Future research must establish which abdominal-obesity index best predicts disease outcomes.

Abdomen↗
PubMed1996

Managing risk in a changing health care system.

This article examines the information requirements and other strategies needed to manage business and financial risk in health care organizations. The business and financial risk of providers in the changing health care market is defined. The major factors that are increasing risk are outlined, and strategies for measuring and managing risk are discussed. The interaction of business and financial risk is described, and strategic goals that will minimize the effect of this interaction are presented.

Capitation Fee↗
PubMed1998

Physician equity in health care delivery systems: three alternative models.

The 1990s have seen many health care organizations attempting to merge, acquire, or affiliate with physician groups. Many have failed to provide physicians a stake in the success of the newly formed enterprise, frequently resulting in declining physician productivity, poor morale, and large operating losses. These problems warrant a reexamination of the traditional acquisition model of growth in favor of structures that retain a physician ownership component. This article examines three models of health care organization in which physicians share in the success of the enterprise and compares them in terms of ownership structure, governance, and funds flow.

Delivery of Health Care, Integrated↗
PubMed1975

Liability and compensation independent of medical negligence: the new Swedish system.

On the 1st of January 1975 a new system of Treatment Injury Insurance was introduced in Sweden. (Until then the rules of tort law governed all liability insurances.) Almost all medical attendance within, and much of the attendance outside, hospitals is managed by County Councils (Landstingen). The new insurance is contracted by the managing County Council to a pool of Swedish Insurance Companies. The total amount of the premiums for this first year is calculated to be 16 milj Skr (4 milj $ = 1/2$ per inhabitant per year). By treatment injury shall be understood "injury or illness of a physical nature...as a direct consequence...of...treatment (excepting natural or probably consequences of an act justified from a medical point of view), or of incorrect result(s) of technical examination or clinical diagnostics, or of accidents in hospitals, doctors' offices or in connection with ambulance services".

Diagnostic Errors↗
PubMedDate not supplied

Public long-term care insurance in Japan.

A public long-term care (LTC) insurance program is likely to be introduced to Japan in the year 2000. A consensus on the need for more LTC resources in the rapidly aging society and dissatisfaction with the current system are some of the factors that have contributed to its introduction. Half the costs will be paid by premiums that will be levied on all those older than 40 years, and half will be covered by general taxation. The insurer will be the municipalities with a pooling mechanism at the national level to balance the differences in their demographic structure. The benefits will include institutional care, respite care, day care, home help, visiting nurses, and loan of devices. Eligibility status will be classified into 6 levels that will be determined by assessment of functional and cognitive status. However, there are few mechanisms to limit benefits and contain costs. Problems also exist in the design of the eligibility classification and in the assessment instrument. The proposed LTC insurance system highlights the need for defining what should be included in a "basic package" of LTC as an entitlement for every citizen, for an organizational mechanism and an assessment instrument to deliver services efficiently and equitably, and for physicians to work outside the traditional medical model. To what degree the Japanese public in general, and physicians in particular, is willing to deal with these issues is a challenge for the 21 st century.

Aged↗
PubMedDate not supplied

Premium increases and disenrollment from state risk pools.

State risk pools exist primarily for persons who want to buy health insurance, but are either medically uninsurable or are only able to find a policy at considerably higher cost than the rate for a standard insured person. While some people enroll in state risk pools for extended periods, many enroll only for a limited time. This study analyzes duration of enrollment in eight state risk pools using data from 1988 through 1991. A discrete time hazard model provides estimates of the relationship between voluntary disenrollment and enrollee and plan characteristics. Among other findings, the regressions provide evidence of substantial increases in disenrollment in most states in response to premium increases that either were implemented by the plan or occurred as enrollees aged into higher risk categories.

Adolescent↗